It is amazing how so many people treat the NHS as if it is some religion to be worshiped, rather than the 3rd world quality consumer service that it is. They fail to realise that other developed countries also have health services, and nearly all of them do it better. The NHS is not the envy of the world, very far from it.
It is very important to understand that the NHS is composed of two completely different things. Firstly it is a compulsory insurance scheme. Everyone pays in, whether they use the service or not. And the service is available to everyone equally, no matter how much or how little they have contributed. All this is good, but why does the state do it? We could just as easily pass legislation to privatise this so that proper insurance companies do the job, as they do in some other countries.
The second element of the NHS is the provision of medical service. In our system this is free at the point of use, instead of paying then claiming. Both methods have advantages and disadvantages. From a users point of view it doesn’t matter whether the provider is the state or private enterprise. For instance all GPs have always been private, they were never nationalised.
So where does the NHS sit in the international rankings. The most thorough and respected research is the Euro Health Consumer Index (you can see their 2014 report by clicking here) the UK came 14th in Europe in 2015 and has never made the top 10 “mainly due to poor accessibility (together with Poland and Sweden the worst among European healthcare systems) and an autocratic top-down management culture”.
The World Health Organisation produced the World Health Report back in 2000 (click here) which had the UK in 18th in the world. Obviously the developing world countries will have become a lot better since, whereas the NHS was trashed by a Labour government (click for article).
There is a report by the Commonwealth Fund in 2014 which put the NHS first! (Click here to see it). But the Commonwealth Fund is an American left wing lobbying organisation who want to bring the NHS to America, so, for instance, they gave high scores for accessibility and free at the point of use. (Click here to see a total demolition of their methodology). However the Commonwealth Fund couldn’t hide the fact that the NHS kills a lot of its patients, coming 10th out of eleven countries on this score.
Bloomberg produce an annual ranking of health services by efficiency taking the crude measures of cost against life expectancy (click to see). This has the NHS at 17th. Despite the NHS telling us what wonderful value for money they are.
The OECD produce Health care systems: efficiency and policy settings (click here). The UK is Group 6, defined as: “Mostly public insurance. Health care is mainly provided by a heavily regulated public system, with strict gate-keeping, little decentralisation and a tight spending limit imposed via the budget process.” Within this group the ratings are: High DEA Score: Norway, Italy. Above Average: Poland. Average: New Zealand. Below Average: UK. Low: Hungary, Ireland. So even amongst like systems the NHS performs badly. The OECD’s analysis of the NHS: “The quantity and quality of health care services (in the UK) remain lower than the OECD average while compensation levels are higher. Reinforcing competitive pressures on providers could help mitigate price pressures, e.g. by increasing user choice further and reforming compensation systems.” Not good.
There is a website called QualityWatch which has internationally comparative graphs for a whole range of medical metrics (click here). These show up just how badly the NHS performs in many areas.
So it’s not looking good for the NHS. What are its problems?:
- Government ownership and control. Everything that the state does it does badly. State organisations do not have to look after their customers, so they don’t. They don’t have to be efficient and make a profit, so they don’t. Compare that with the free market where an organisation has to be efficient and has to look after its customers, otherwise it goes bust. So it is hardly surprising that the world’s best health services are largely privately run. They can still provide universal care free at the point of use. They are just much better at it.
- Immense monolithic organisation. The NHS is the world’s 5th biggest organisation with 1.7 million employees, up from 1.5 million in 2010, as the Conservatives have thrown money at it. The US Department of Defence, Chinese Army, Walmart and McDonalds are the only bigger organisations on the planet. This makes it pretty unmanagable. When the NHS was first formed the Conservatives were going to implement a far better structure had they won the 1945 election (learn about it here). But Labour won and imposed a centralised Marxist structure so as to increase their control over people.
- Waiting lists. The flow of customers and the availability of service are obviously in balance, otherwise the lists would get longer. So the existence of lists is purely, 100% bad management. Other health services don’t have them, or only have a minimal wait. People’s condition get worse whilst they are waiting, some of them die, many are in severe discomfort. This is Marxism at work, the organisation comes first and dictates to the masses. There is no beginning of a concept of customer service.
- Poor diagnostics. If you are pregnant then you are OK, but for many other conditions the NHS just will not find it, or will give up after trying a bit. The cynical might say that they don’t have to pay to treat things that they haven’t found. The result is a culture where instead of treating conditions they treat symptoms. Proof of the poor diagnostics is the immense regional variation, which can be seen in the NHS’s own Atlas of Variation (click here to see it). Why do commissioners in one locality commission over four times the number of audiology assessments per head of population than commissioners in another?
- Medical incompetence. The NHS spends nearly a quarter of its budget not on healthcare but on compensation for negligence and on lawyers handling claims against it. £26.1bn out of £113bn. (Click here for article). This is one of the very worst performances of any health service in the world.
- Attitude. Because it is a Marxist organisation, because there is no market competition and because it is free at the point of use the NHS behaves as if everything they do for you is a favour, a result of their generosity. But in reality you have paid for the service, you are a customer and you should be treated like one. They work for you, but you would never think so.
- Inefficiency. Some people in the NHS work genuinely hard, but spend any time in any NHS institution and you will see a lot of tea and gossip culture and a lot of people doing non jobs with incredibly low levels of productivity. This is because the trade unions rule the roost, because of inept management and because there is no compunction to look after customers.
- Excess “management”. Except they aren’t really management, they are administrators, counting the metaphorical paperclips. And a huge amount of the NHS budget is wasted on them. The number of NHS managers in England rose by 37 % between 1997 and 2010, they consume more than 15% of the NHS budget, a high figure by international comparison (click). And remember they don’t have to make a profit or look after customers, they just have to spend money.
- Lack of patient choice. You are the customer, you have paid for the service, yet the NHS dictates to you in a way that you would not tolerate from any other provider of services. Eye care and dentistry have been semi privatised, mostly even taken out of the state insurance element. And look how vastly superior the customer care and choice is. When they have to compete for your custom they suddenly become a whole lot better.
- Health care rationing. Your GP decides whether you can see a consultant, the consultant decides whether you will be properly investigated and then if you will be treated. The pushy middle class win out by browbeating till they get what they want. The NHS uses the cheapest drugs possible and only upgrade you to something better if that doesn’t work. Without rationing we would not be able to run the NHS as it currently is. So we don’t treat all those who need it or to give everyone the best treatment.
- Abuse of the system by patients, partly because it is “free”. When I was young a woman we knew was stuffing her pillows with prescription cotton wool. Two thirds of people attending hospital A&E should not be there (click). More than a million A&E admissions each year (up to 35% of the total) are alcohol related. The NHS does tattoo removal, breast enhancement, fertility treatment and homeopathy. It shouldn’t. People not turning up for appointments costs nearly £1Bn per annum. Most NHS patients are there because of self inflicted conditions; obesity, smoking, bad diet, alcohol and drug abuse. By 2011 25% of our population was obese which causes a wide range of medical conditions, from diabetes (10% of NHS spending), through heart disease to varicose veins and joint failure. Yet the whole monolith does not systematically try to fix this, they are too busy trying to treat symptoms.
- Huge numbers of badly trained third world doctors (link). For instance we have about 25,000 Indian doctors. But Indian medical schools are rife with corruption (link). And Indian trained doctors are four time more likely to be struck off in Britain (link).
And so it goes on. The NHS is fundamentally, structurally broken, it looks after its patients badly compared with other, similar, services in other countries. The main problem is its state run, monolithic, Marxist structure. It needs to be broken down into large numbers of independent, competing providers giving true customer care, choice and quality of provision. Until that happens it will always be crap.
This post was originally published by the author 4 May 2016: http://www.bruceonpolitics.com/2016/05/04/why-the-nhs-is-crap/